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ACP recommends cognitive behavioral therapy over drugs for treating chronic insomnia

Cognitive behavioral therapy for insomnia (CBT-I) should be the first-line treatment for adults with chronic insomnia, according to the American College of Physicians (ACP). The new evidence-based clinical practice guideline is published in Annals of Internal Medicine.

CBT-I consists of a combination of treatments that include cognitive therapy around sleep, behavioral interventions such as sleep restriction and stimulus control, and education such as sleep hygiene (habits for a good night’s sleep). A review of published evidence found that CBT-I is an effective treatment and can be initiated in a primary care setting. While the reviewers found insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms than sleep medications, which are associated with significant side effects.

If CBT-I alone is unsuccessful, ACP recommends that doctors use a shared-decision making approach with their patients to decide whether drug therapy should be added to treatment. This should include discussing the benefits, harms, and costs of medications.

Recommendation DOI: 10.7326/M15-2175
Evidence Review 1 DOI: 10.7326/M15-1781
Evidence Review 2 DOI: 10.7326/M15-1782
Editorial DOI: 10.7326/M16-0359